How to Convince Insurance Company to Cover Tummy Tuck?

I went to see about a tummy tuck and the doctor said I was a good candidate to have it done. As soon as she heard of my insurance, she said no they do not cover that. With me having hip pain, back pain, unable to do many exercises from excess skin, how does a doctor let my insurance company know it is not just cosmetic. She did not even try to help me get my insurance company to do the surgery. I would like some help in this area.

Your Insurance Company Will NEVER Pay for a Tummy Tuck

A panniculectomy is a functional procedure for removing excess skin and fat. An insurance company MAY authorize a panniculectomy if...

The apron of excess abdominal skin impedes walking.

The apron of excess abdominal skin impedes normal groin hygiene.

There are recalcitrant fungal infections beneath the skin folds.

The infections have progressed to bacterial infections, necessitating hospitalization and IV antibiotics.

A panniculectomy is NOT an attractive operation. The goal is function, not cosmesis.

There is no tailoring of the skin excess.

There is no liposuction to contour the flanks.

The bellybutton is not preserved.

The muscles are not tightened.

The abdomen is not optimally flattened.

If your goals are functional, then you should consider a panniculectomy. Find a Board Certified Plastic Surgeon who accepts your insurance, and then speak with him/her frankly.

If, however, your goals are too have a more attractive torso, then you are looking for an abdominoplasty, better known as a tummy tuck. Obviously, no insurance company is going to pay for you to look cuter; that's your financial responsibility.

Tummy tuck and insurance

November 2nd, 2009

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi, the only thing that insurance companies will cover is a panniculectomy, which is removal of the overhanging skin. Most companies will ask for documentation that you have seen a dermatologist for recurring rashes between the skin folds, and that you have undergone a significant weight loss which produced that excess skin. They will not cover tightening of the muscles which is done with a cosmetic abdominoplasty. It is fraudulent for a physician to bill an insurance company for a cosmetic procedure. Good luck, /nsn.

Tummy Tuck Pictures

Abdominoplasty is not covered by insurance companies

October 28th, 2009

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi,

Although most patients don't like it, abdominoplasty is considered a cosmetic surgery procedure and, as such, is not covered by insurance companies. The only operation that insurance companies will consider covering is a panniculectomy, in which a wedge resection of the lower abdominal skin is performed; the abdominal wall is not tightened, the skin is not lifted off the abdominal wall, and the belly button is not relocated. Insurance companies will usually only covering that procedure if patients have problems with skin breakdown, rashes, or difficulty walking due to the amount of the overhanging skin. It is no way a cosmetic procedure and the results are not comparable to abdominoplasty. If you have documentation of the above-mentioned problems, you may be a candidate for a panniculectomy.

Good luck on insurance coverage of Tummy Tuck

October 28th, 2009

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In general, the answer is NO. The only way you might have insurance coverage for tummy tuck is if you have constant rashes from the skin overlap and your dermatologist has tried for a long time unsuccessfully to treat it.

Insurance coverage for tummy tuck

October 28th, 2009

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Insurance companies do not cover tummy tucks, they are cosmetic. They do cover panniculectomy(removal of overhanging skin) when the patient meets the criteria. Each insurance company has their own criteria so you should talk to them first. They will also cover hernia repair but not the tightening of the muscles or repair of diastasis recti. Many plastic surgeons feel it is a waste of time and money for them to check with the insurance company but as the person who is covered by the insurance company you certainly should check.

Tummy tuck or panniculectomy

October 28th, 2009

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Based on the photo this is not a tummy tuck, The abdomin is very large and hangs down below the pubic area. Sometimes the insurance will pay for a panniculectomy. The panniculectomy is the removal of the excess skin that hangs below the pubic area and nothing more to get A nice looking taylored abdomin you would have to pay for the cosmetic part of the procedure otherwise you would still have an abdomin that you did not like. Even when the insurance company states that it is a covered procedure ( the Panniculectomy) the insurance company ends up not paying for it or taking numerous appeals and letters and months even years of time befor they make a final determination.

Most doctors do not want to and cannot afford to do a surgery that involved and then recieve $1100 as the entire payment and have the insurance company argue about it for such a long time. That is why the procedure was divided into a cosmetic part and a medically necessary part .

To summarize a panniculectomy only removers the skin hanging below the pubic area and the abdominoplasty is the part that makes it look good by tayloring the skin and relocating the umbilicus. The second part is cosmetic and payed by the patient.

How to Convince Insurance Company to Cover Tummy Tuck?

December 30th, 2014

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I have never had an "insurance" entity authorize tummy tuck surgery. In other words, insurance companies do not consider this operation medically necessary. Sometimes, however insurance companies will cover excision of lower abdominal wall skin/apron; this operation is called a panniculectomy. Best wishes.

How to convince insurance company to cover tummy tuck?

August 2nd, 2014

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Often times a detailed description of your complaints as well as photos is mandatory. It i also the surgeon's obligation not to attempt to get procedures purely cosmetic through insurance. Given your photo, it does not appear that your abdominal panniculus would warrant insurance coverage and there is no literature evidence between panniculus with hip/back pain.

Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Best wishes!

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.